Boys and Eating Disorders

Boys and anorexia — it's not just a female problem.

At first, it was about getting a date. Jared was a sophomore in high school when he noticed that the girl who caught his eye liked "really thin guys."

So in the spring, just as he was turning 16, Jared decided to lose weight. But what began as a mission to slim down soon became a secret, painful battle with food. He became obsessive about calorie counting, keeping a running tally of the day's intake on a scrap of paper, and exercised compulsively. According to his mother, Janice, he developed "weird eating habits." She describes seeing her teenage son limit himself to a lunch of three apples and some shredded wheat or a bag of carrots. When his sister, Jody, came home from college, she was instantly alarmed: Jared, five feet six inches, had dropped from 147 to 126 pounds in six months.

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Still, Jared wasn't satisfied. If only he were thinner, he remembers thinking, maybe he would feel more confident, more outgoing. Maybe that girl would notice. When he left for summer camp, he began "a kind of game with myself: Every day I would eat less and less." An apple and a yogurt for breakfast one day was reduced to an apple and half a yogurt the next. He would slip out at night or during social events to run. By summer's end, he was running four and a half miles a day and consuming fewer than 500 calories -- behavior typical of anorexics, who deny themselves food and exercise to excess. He came home weighing 112 pounds.

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"He started losing muscle mass," recalls his father, Jimmy, sitting in the living room of the family's home in Salem, N.H. "You would touch his shoulder and feel bone."

Worried, his mother brought Jared to the doctor. "I was expecting the doctor to say, 'Boy, that's a lot of weight you've lost. what's happening?'" But he didn't even question it, says Janice. When she brought it up, the doctor dismissed her concerns.

Everybody's Problem

Traditionally considered a women's problem, eating disorders are now being diagnosed more frequently among young men. Some 8 million Americans suffer from these disorders. Conservative estimates suggest that one in 10 sufferers is male, although some experts put the ratio as high as one in six. All agree that uncounted young men have eating problems that are less serious but still physically and emotionally destructive.

The obsession with weight loss and a fear of food are all too familiar to Dan Fox, an 18-year-old high school senior. As he sits in the den of his family's home in Sterling, Massachusetts, Dan, a straight-A student and aspiring film director, quietly describes his two-year struggle with anorexia. He has been hospitalized a half-dozen times, he says, sometimes for weeks at a stretch.

As a child, Dan was teased for being "on the chubby side" and he began to equate thinness with happiness: "I can just remember being unhappy, and I figured I had seen people who were skinny and good-looking, and no one like that was ever unhappy."

At one point, Dan was running 10 miles and eating just one bowl of cereal a day. Even after his weight fell so low that he was prohibited from running, he would jog in his room, back and forth, for an hour after everyone in his family had gone to bed. His health was so precarious he had to be weighed and have his vital signs checked several times a week.

His doctor, Richard C. Antonelli, M.D., says that even though Dan would claim to feel perfectly fine, the eating disorder was jeopardizing his life. His pulse rate was very low -- in the mid-40s when it should have been 70 to 85 beats per minute. And the lack of protein in his diet was causing his body to break down its own proteins, weakening his heart and putting him at risk for heart failure.

"I was very concerned about Dan," says Dr. Antonelli, assistant professor of pediatrics at the University of Massachusetts Medical Center in Worcester. According to Dr. Antonelli, Dan, like many other anorexics, was in denial: "It was very difficult, initially, for him to recognize he had a problem."

Asking for Help

Unlike Jared, who knew he needed help, Dan was angry with doctors who put him in the hospital and insisted he eat. But, after repeated hospitalizations and being rushed to the intensive care unit on one occasion, Dan eventually was able to see that something was terribly wrong. With the help of psychotherapy and medication, Dan is now trying to put the disorder behind him. He shows off his basement hangout, where he and friends play pool and Nintendo, and listen to music. He points to a photo of himself with his girlfriend at the junior prom. He has plans for college -- and for his life. But he realizes he has a long way to go.

"I just want to be able to eat normally," he says. Although he eats three meals a day, he is so rigid about his diet that it is difficult for him to eat anywhere but at home. Typically he will eat two bowls of cereal with skim milk for breakfast, turkey with soy organic cheese on pita bread for lunch, and small portions of spaghetti, chicken or beef for dinner. "All junk food I am scared of. I don't eat anything fried," he says. Eventually, he adds, he'd love to just be out during the day and "be able to stop someplace and eat something."

Experts say there is no easy way to explain why young men develop eating disorders. But some of them point to the powerful messages from the mass media on physical appearance. Girls have long been influenced by unrealistic images, ranging from the slim yet buxom Barbie doll to waif-thin model Kate Moss; now boys seem to be finding their own equivalents. "The physical standards are becoming just as impossible for men as they are for women," says Arnold Andersen, M.D., one of the nation's experts on male eating disorders.

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The new male standard is a svelte body with clearly articulated muscles. It can be seen in ads, on TV, in the movies, in video games, even in children's toys. That image is taking a toll. Dr. Andersen, director of the eating disorders program at the University of Iowa College of Medicine, says his latest research on boys reveals that some 80 percent are dissatisfied with their bodies: "Half want to bulk up, and half want to lose."

The Accepted Ideal

At McLean Hospital in Belmont, Mass., researcher Harrison Pope, M.D., displays plastic action figures on a coffee table in his office. Dr. Pope, a psychiatry professor at Harvard Medical School, lines up three G.I. Joes -- designed in 1964, the mid-1970s, and in 1992, respectively. His point is easy to see: The 1964 G.I. Joe looks like a trim, regular guy. The mid-'70s G.I. Joe is more muscular. And the newest model? Dr. Pope points out the rippled muscles, the "six-pack" of perfectly sculpted abdominals. "Not only is the modern Joe more muscular, he's leaner," Dr. Pope observes.

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Of course, few young men are consciously trying to emulate plastic action figures. But the figures do underscore the shift in the masculine ideal, says Dr. Pope, co-author with Katharine Phillips and Roberto Olivardia of the recently published The Adonis Complex: The Secret Crisis of Male Body Obsession.

The preoccupation with physical appearance is filtering down to elementary schools, where experts see more pressure on boys at frighteningly young ages. "Not only do I hear of first- and second-grade girls coming home and asking, 'Mommy, am I too fat?' but now I hear third-, fourth-, and fifth-grade boys saying, 'Am I buff?'" says Catherine Steiner-Adair, Ed.D., director of education, prevention, and outreach at the Harvard Eating Disorders Center in Boston, and a clinical and consulting psychologist. Steiner-Adair says middle school boys "actually think seriously about working out and weight lifting for body sculpting purposes."

For 22-year-old Matt Berkeley, teased for being overweight from the time he was nine years old, the images of lean, muscular bodies in magazines such as Men's Fitness, Flex, and Men's Health, were impossible to resist. He wanted to look like that, too. "I was amazed that the human physique could be so shaped, so symmetrical," recalls Matt, who lives in Waltham, Mass. "I would see these guys with these perfect physiques, and it just motivated me toward my goal."

One Man's Story

Matt began his quest for such a body after graduating from high school. "I did a whole makeover of myself," he says. He began simply enough, exercising regularly and watching what he ate. But it wasn't long before he was lifting weights two and a half hours a day, six or seven days a week. "The exercise was very addictive," he says. "Muscles were popping out everywhere; I was losing body fat."

But Matt wanted more. He read books on training and on food supplements -- books with sometimes dangerous prescriptions for bulking up and losing fat. "I learned about how ephedrine [mixed with other drugs] can have synergistic effects for fat-burning," he says. Ephedrine is an ingredient in some nutritional supplements available at health food stores and other retail outlets. It can raise blood pressure, cause insomnia, and even lead to stroke.

Matt limited his food intake to exactly 1,600 calories a day -- the amount he could burn off at the gym. He took ephedrine, often several times a day. His weight, once 185 pounds on his five-foot-eight-inch frame, dropped to 138 pounds. His waist shrank from 33 inches to 29 inches.

Fortunately for Matt, his drastic weight loss was only temporary. Although never formally diagnosed with an eating disorder, he realized something was wrong. He began psychotherapy. He enrolled in a community college and started thinking about his future. A relationship with a girlfriend blossomed.

He pulled himself out of his destructive cycle, cutting out ephedrine and eating whenever he was hungry. "After that, I was basically home free," says Matt, now 185 pounds and fit. "I finally accepted myself the way I was. I still try to better myself, but I don't go to extremes."

Beyond Body Image

Mass media images aside, experts say male eating disorders are often part of a larger web of troubles that often includes depression. "You will never find one thing that is the original source," says Laura Goodman, a psychotherapist in private practice and author of Is Your Child Dying to Be Thin? "These disorders are not illnesses, but coping mechanisms -- faulty ones."

For boys suffering from bulimia or binge-eating disorder, Goodman says, food serves as a tool for dealing with suppressed emotions. Bulimics consume large amounts of food and then "purge" by exercising excessively, using laxatives or vomiting, or fasting between binges. The binge eater consumes food uncontrollably, but doesn't purge. Like anorexia, bulimia and binge eating can cause serious health problems, from mood swings to osteoporosis, kidney failure, heart failure, even death.

Boys with bulimia treat food as "their drug of choice," Goodman says, "stuffing negative feelings down in the body. When they throw up the food, they throw up the feelings." By contrast, anorexics, who often deny themselves food, find that eating may be the one thing in their lives they can actually control.

Some studies point to the challenge of coping with emerging sexuality as the stress point that triggers a disorder. David Herzog, M.D., president of the Harvard Eating Disorders Center, says boys are most likely to develop eating disorders around puberty or a few years later, when they prepare to leave home for college. Other research suggests there may be higher rates of eating disorders among gay males.

Research also points to a link between eating disorders and participation in sports such as wrestling, swimming, gymnastics, or running, in which a lower weight -- or, alternatively, a bulkier build -- may be a competitive advantage. In 1997, three college wrestlers exercised (and dehydrated) themselves to death trying to lose weight in order to compete in lower weight classes.

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The Root of The Disorder

The seeds of eating disorders may be planted early and innocently when children turn to food to make themselves feel better. "There are a lot of kids who come home to an empty house and, until Mom or Dad gets there, find comfort in food," Goodman says. "That can be a precursor to an eating disorder."

Children who are encouraged to diet are also at greater risk, experts say; they emphasize that weight issues in youngsters should be tackled through healthy eating and regular exercise.

Jared found that once he started losing weight, it was hard to stop. "Every time I looked in the mirror, I thought, I could definitely lose this or I could definitely lose that," he says, pinching his waist in a mock gesture. Food became so threatening that Jared would avoid social events where he would have to eat -- or he would lie and say he'd already eaten.

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Jared, 19, continues to work on his recovery and credits his psychotherapist with helping him in his continuing effort to recover from anorexia. He looks healthy and estimates his weight at 150 pounds, though he is not certain because he no longer weighs himself. He eats, but confines himself to a limited diet. And he still struggles to eat in public, preferring to have his meals alone.

"I think it would be great if I could have a meal and not think, 'How many calories does this have?' or 'Should I go exercise?'" he says. "A goal for me is to go out with friends and eat and not think more about the food than about the conversation we are having."

Eating disorders were once considered to be a "girl problem" — but not anymore. Now, teenage boys are frequently diagnosed with anorexia and bulimia, too. Some 8 million Americans suffer from eating disorders, and conservative estimates suggest that as many as one in six is male. If you suspect that your child is suffering from an eating disorder, immediately call your family doctor and an eating disorders center, such as the ones listed below.

When Your Son Has an Eating Disorder: A Resource List

The National Eating Disorders Association is the largest not-for-profit organization in the United States working to prevent eating disorders, eliminate body dissatisfaction, and provide treatment referrals to those suffering from anorexia, bulimia and binge eating disorder and those concerned with body image, eating and weight issues.
(206) 382-3587; toll-free information and referral helpline (800) 931-2237; nationaleatingdisorders.org

The National Association of Anorexia Nervosa and Associated Disorders (ANAD) is a national nonprofit organization helping eating disorder victims and their families. In addition to free hotline counseling, ANAD operates an international network of support groups for sufferers and families, and offers referrals to health care professionals across the United States and in 15 other countries.
(847) 831-3438; anad.org

The International Eating Disorder Referral and Information Center provides referrals to eating disorder practitioners, treatment facilities, and support groups. It also offers general information about the treatment and prevention of eating disorders.
(858) 792-7463; edreferral.com

Before you complain about the fat in your salad dressing or make a fuss over a calorie-laden dessert, realize that your kids are paying attention. "Parents shouldn't pass on their anxieties about food," says Catherine Steiner-Adair, Ed.D., a clinical and consulting psychologist who is director of education, prevention, and outreach at the Harvard Eating Disorders Center in Boston.

Parents need to make it clear that people come in all sizes and shapes, Steiner-Adair says. "By age six, both boys and girls know the cultural value placed on thinness. They have a general sense that fat people are bad or less worthy, which is so unfair."

Don't use food to comfort your child. "A child falls and skins a knee, and we say, 'Here, have some ice cream,'" says Laura Goodman, psychotherapist and author of Is Your Child Dying to Be Thin? "We start very innocently saying that food can make you feel better. And that delivers a dangerous message."

Don't place certain foods "off-limits." Children who clamor for the junk food they see in their classmate's lunch box should be allowed to have some. Dividing food into "good" and "bad" may set up future problems.

Above all, don't put your child on a diet. If a child is overweight, find fun ways for him to spend time in active rather than sedentary activities.

Warning Signs and What to Do

If your child avoids meals with the family, heads for the bathroom after eating, is losing weight, exercises excessively, or seems withdrawn, it's time for a discussion. Begin with something like, "I'm concerned about you. It seems as if you have lost weight." Get him to talk about it.

If you're not satisfied with his answers, and suspect he has a problem, get treatment right away. The longer he lives with the disorder, the harder it is to recover from it. Treatment may include the use of medications and behavioral therapy, in which a psychotherapist helps the child overcome his fears of eating certain foods or helps him find alternatives to bingeing and purging.